Just informal patient payments are not enough, ‘personal connections’ and knowledge of the ‘rules’ are also required: a logistic regression analysis of informal practices in health care in Ukraine

Olena Levenets, Tetiana Stepurko, Abel Polese, Milena Pavlova and Wim Groot

Health Economics, Policy and Law, 2025, vol. 20, issue 1, 64-84

Abstract: In Ukraine, patients and their family members face numerous barriers to health care services. In response, they use coping strategies, that are manifold and complex activities aimed at overcoming these barriers, the financial burden of the treatment, and the poor quality of health care services. These activities include formal and informal practices. Based on representative survey data from 2015 (N = 2,022), we identify patterns in the use of coping strategies, specific coping strategies used to secure good quality consultation and treatment, and analyse opinions and actions towards coping practices. We further analyse the factors associated with the last experience of coping and look at patterns of connection building. We find that the chances of using both money and connection as a coping strategy are higher for people with incomplete higher and highest levels of education. The size of this effect increases with the level of education. Older people, people with better health, and people with a higher opinion of the state use informal practices less, while women are more active in developing connections. The closer the relationship is with a medical doctor, the higher is the chance that such connection will be used in case of health service consumption.

Date: 2025
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